Acute ischemic colitis in elderly: medical or surgical urgency?

Background

Ischemic colitis is frequent disease in the elderly population. Early medical or surgical treatment is the key factor for a favourable prognosis. Many clinical, biohumoral and pathologic factors had been considered to indicate better treatment. "Severity" of the disease seems a prognostic factor for surgery. Aim of this study is to identified objective factors predictive of the better type and time of treatment.

Materials and methods

Seventy-two elderly patients (m:39, f:33; median age 74.8 years) affected by ischemic colitis were observed in the Surgery Unit of the University of L'Aquila from 1986 to 2008. The clinical records of the patients were reviewed retrospectively in order to asses clinical, biohumoral, endoscopic and x-ray findings predictive of the most suitable treatment. Clinical follow-up was implemented to evaluate the long-term prognosis after mean period of 6 years post treatment.

Conclusion

In conclusion, our results seem to suggest that medical therapy is the mainstay of treatment for acute ischemic colitis in elderly patient with good results. Surgery, with high rate of postoperative morbidity and mortality is indicated only in cases of peritonitis. Segmental resection of colon with ischemic lesions is the gold standard.